The purpose of this renewal application is for funding of the existing Occupational and Environmental Medicine (OEM) Residency at the University of Pennsylvania (UPENN). The largest civilian OEM residency program in the nation, this unique, innovative, train-in-place OEM program, with measureable outcomes, in existence since 1997, was created in response to the National Academy of Medicine's call in 2000 to develop new routes to OEM certification. Designed to train midcareer physicians it was recently expanded to also train recent medical school graduates. Aligned with Healthy People 2020, the program trains physicians to promote the health and safety of people at work through prevention and early intervention. The program is also aligned with the National Occupational Research Agenda, now in its third iteration, to implement improved workplace practices, training qualified physicians to carry out the purpose of the Occupational Safety and Health Act. It is competency-based and helps address the national shortage of OEM physicians in the US, allows trainees eligibility for the American Board of Preventive Medicine Examination (ABPM) and equips them with improved clinical, administrative, teaching, population management and research skills. The overall purpose is to graduate 30 trainees over the 5-year grant period, including 5 NIOSH supported. Qualified applicants have completed at least 1 clinical year and have a Master of Public Health or equivalent degree, or a plan for completing the degree before graduation, in keeping with American Council of Graduate Medical Education (ACGME) requirements. There are two tracks: Internal Track (IT) and External Track (ET). The UPENN External, train-in-place, track helps overcome barriers that deter otherwise motivated physicians from specialist training. ET residents work full-time as OEM physicians at an approved clinical training site (CTS) supervised by an ABPM certified physician. IT residents, usually more recent medical school graduates, rotate at the UPENN and affiliated hospitals, governmental agencies and industry. The program has two interrelated are: the applied component at the CTS and the didactic component that consists of monthly 3-day sessions at PENN: 12 sessions during the first year and 5 during the second year. Both components work in tandem to allow acquisition of the ACGME milestones, program and American College of OEM competencies, and success on the certifying examination. Faculty are national experts in the specific area they teach and are ABPM diplomats. The program has graduated 134 residents since inception. Graduates comprise a diverse workforce, are geographically dispersed representing every US region with most working outside of the 25 largest standard metropolitan statistical areas. They express satisfaction with training, achieve all milestones, score competitively on the certifying examination. Graduates comprised 8% of new ABPM diplomates over the past decade. More than 95% have remained in the field.